Atherosclerosis-related cardiovascular or cerebrovascular diseases
Atherosclerosis-related diseases are the leading cause of morbidity or mortality in the world. They result in serious outcomes such as sudden cardiac death, unstable angina pectoris, acute myocardial infarction, stroke, or intermittent claudication due to vessel obliteration or plaque rupture with subsequent thrombosis. There are some limitations with standard treatments such as antiplatelet drugs, angiotensin-converting enzyme inhibitors, beta-blockers, coronary artery bypass surgery, and percutaneous transluminal coronary angioplasty. Therefore, complementary and alternative medicine is necessary for medication. Traditional Chinese medicine is the main complementary therapy used in the Chinese community. This article aims to explore complementary therapy with traditional Chinese medication for atherosclerosis-related diseases. There is some scientific evidence to support that traditional Chinese medicine could treat atherosclerosis and its associated conditions. Acupuncture through needling on ST36, ST40, PC6, or BL15 could alleviate atherosclerosis-related cardiovascular diseases. Tai chi and meditation have beneficial effects for mental and physical health. In addition, extracts or compounds of single Chinese herbs such as Salvia miltiorrhiza, Panax notoginseng, Ginkgo biloba, Curcuma longa, Crataegus pinnatifida, Paeonia lactiflora, Prunella vulgaris, Polygonum multiflorum, Coptis chinensis, and red yeast rice also could treat atherosclerosis-related diseases through their endothelial protective, antioxidative, anti-inflammatory, inhibiting of smooth muscle cells proliferation, and lipid-lowering effects. In accordance with evidence-based medicine, well-designed and conducted clinical studies such as randomized control clinical trials will be necessary in the future.
- complementary medicine
- traditional Chinese medicine
Atherosclerosis is the most common type of arteriosclerosis. It is a disease of the arteries characterized by the deposition of fatty plaques on their inner walls, which hardens or narrows medium to large blood vessels, especially the aorta, coronary arteries, and cerebral arteries . Atherosclerosis-related diseases often lead to serious outcomes such as sudden cardiac death, unstable angina pectoris, acute myocardial infarction, stroke, and intermittent claudication due to vessel obliteration or plaque rupture with subsequent thrombosis [1,2]. Epidemiological studies indicate that, because of the adoption of Western lifestyle, the prevalence of atherosclerosis is increasing all over the world and will likely reach epidemic proportions in the coming decades . The earliest visible lesion in the development of atherosclerosis is the fatty streak. It consists of aggregates of foam cells (i.e., lipoprotein-loaded macrophages) in the subendothelial space. Fatty streaks may also include T cells, aggregated platelets, and smooth muscle cells. A fatty streak is the precursor lesion of an atheroma that may become an atheromatous plaque . In response to plaque growth, the arterial wall can remodel itself by increasing its external diameter to accommodate the plaque without narrowing the lumen. Thrombosis is the last stage in the disease process that is responsible for clinically observable adverse events mentioned previously.
Traditional Chinese medicine (TCM), especially herbal medicine, has been used for the treatment of cardiovascular diseases for hundreds of years, as documented in the
2. Pathology and risk factors of atherosclerosis
The pathology of atherosclerosis is a progressive process with increasing age that is related to some risk factors such as hypertension, hyperlipidemia, diabetes mellitus, obesity, and cigarette smoking . Atherosclerosis begins with damage to the endothelium, which results in endothelial vasodilator dysfunction. The endothelium subsequently cannot modulate tone, growth, hemostasis, and inflammation throughout the circulatory system. Injured endothelial cells (EC) produce cell surface adhesion molecules such as vascular cell adhesion molecule-1 (VCAM-1), and thereby cause monocytes and T-lymphocytes to adhere to the endothelium and migrate beneath it [1,2]. Circulating monocytes and T-lymphocytes provoke an inflammatory response. The tight junctions between EC loosen and increase the permeability to lipids, especially low-density lipoprotein (LDL). Once the oxidation of LDL has crossed the damaged endothelium into the intima, monocytes differentiate into macrophages and begin to take up oxidized LDL . Macrophages bite and retain the lipid, and then become foam cells. The fatty streak consisting of lipid-containing foam cells in the arterial wall can evolve into atherosclerotic plaques or atheromas . In addition, T-lymphocytes secrete cytokines that induce vascular smooth muscle cells to migrate from the media to the intima and proliferate shortly thereafter . Over time, a growing lesion consisting of lipid and smooth muscle cells invade and narrow the lumen of the artery. Other extracellular matrix (ECM) components such as collagen, elastin, glycoprotein, and proteoglycans give tensile strength and viscoelasticity to the arterial wall. Increasing the synthesis of ECM components such as matrix metalloproteinases (MMPs) contributes significantly to ECM destruction, which renders the plaque more prone to rupture . Once a plaque ruptures, it can trigger an acute thrombosis or embolism by activating platelets. It may finally lead to myocardial infarction, stroke, and even death.
3. Conventional treatment of atherosclerosis
Atherosclerosis treatment usually begins with lifestyle changes such as a low cholesterol diet, regular exercise, and quitting smoking. Depending on the severity of the disease, a person may be prescribed oral medication such as antiplatelets, angiotensin-converting enzyme (ACE) inhibitors, or beta-blockers. In patients with advanced disease, certain medical procedures such as percutaneous transluminal coronary angioplasty or coronary artery bypass surgery may be necessary.
4. Status and purpose
Conventional medical costs paid by patients or by the Bureau of National Health Insurance (Taipei, Taiwan) are expensive. The caregiver burden on the patients’ families and government has increased yearly. In addition, conventional therapies for atherosclerosis-related diseases have some limitations such as statin-induced rhabdomyolysis or hepatitis, and antiplatelet agent-related gastrointestinal bleeding or peptic ulcer. Complementary and alternative therapy is another option for atherosclerosis medication. Traditional Chinese medicine is the primary complementary therapy used in the Chinese community. The aim of this paper is to explore complementary therapy with traditional Chinese medication for treating atherosclerosis-related diseases.
5. Atherosclerosis corresponds to blood stasis syndrome
According to TCM theory, obstructed circulation of blood results in blood stasis syndrome (Xue Yu), which is an important pattern of slowing or retardation of the blood circulation. The main symptoms may include stabbing pain with a fixed position, tenderness, local purpura, lumps, dark-purple lips and finger nails, a blue-purple tongue, and a thready or hesitant pulse. Blood stasis syndrome in TCM corresponds to atherosclerosis in modern Western medicine. Both blood stasis syndrome and atherosclerosis are the predevelopment or initial stage of ischemic heart disease, myocardial infarction, or stroke (Figure 1). With early treatment by medication, the progression of cardiovascular or cerebral vascular disease will not worsen.
6. Atherosclerosis-related cardiovascular or cerebral vascular diseases
Table 1 shows atherosclerosis-related cardiovascular or cerebrovascular diseases. Atherosclerosis can cause embolism, thrombosis, ischemia, infarction, stenosis, or occlusion of the arteries. Some Chinese herbs can promote blood circulation or remove blood stasis and may be useful for treating atherosclerosis-related diseases.
|4400||Atherosclerosis of the aorta|
|4149||Chronic ischemic heart disease, unspecified|
|4148||Other specified forms of chronic ischemic heart disease|
|4118||Other acute and subacute forms of ischemic heart disease|
|410||Acute myocardial infarction|
|4110||Postmyocardial infarction syndrome|
|412||Old myocardial infarction|
|4297||Other certain sequelae of myocardial infarction, not elsewhere classified|
|444||Arterial embolism and thrombosis|
|4292||Cardiovascular disease, unspecified|
|433||Occlusion and stenosis of precerebral arteries|
|434||Occlusion of cerebral arteries|
7. Chinese single herbs and atherosclerosis-related diseases
7.1. Effect of herbal extracts/compounds on the initiation of an atherosclerotic lesion
Several strategies exist for the treatment of atherosclerosis and associated diseases such as risk factor modification, antioxidation, anti-inflammation, and antiplatelet accumulation. Hypercholesterolemia, a primary risk factor that leads to atherosclerosis, is associated with the development and progression of atherosclerosis. Hypercholesterolemia and endothelial injury lead to the infiltration of LDL particles into the subendothelial space. Lowering cholesterol can provide the initial blockade .
The 10 traditional Chinese herbs commonly used in clinical practice that reportedly reduce the production of LDL and/or oxidative LDL are
As Table 2 shows, single compounds and/or herbal extracts from these 10 TCM herbs inhibit the expression of adhesion molecules (i.e., VCAM-1 and ICAM-1). Among them,
|Red yeast rice||||||||||||[26, 41]|
7.2. Effect of herbal extracts/compounds on the propagation of an atherosclerotic lesion
Stimulated by inflammatory cytokines such as interleukin-1α (IL-1α) and TNF-α, VSMCs propagate and migrate from the media to the intima and produce collagen, which forms the substance of the fibrous cap of the mature lesion [1,20]. Signaling interactions between CD40- and CD40L-expressing cells result in the formation of matrix metalloproteinases (MMPs), which degrade collagens and the thin fibrous cap and lead to the formation of vulnerable plaques and rupture . Among the 10 TCM herbs,
|Reduce caspase-3, and VSMC migration
|Cryptotanshinone||Increase NO; reduce ox-LDL, ICAM-1, VCAM-1, and monocyte adhesion|||
|Tanshinone IIA||Reduce ROS, Bax/Bcl-2, caspase-3, LOX-1,
NF-κB, ox-LDL, monocyte adhesion, VSMC
migration and proliferation, macrophage,
cholesterol accumulation, CD 40, TNF-α
MMP-2, MMP-9, and platelet aggregation
||Reduce ICAM-1, E-selectin, NF-κB, ox-LDL,
MMP-2, and MMP-9
||Reduce ICAM-1, VCAM-1, ox-LDL, IL-1β, MMP-9, MMP-2,
NF-κB, CD40, and MCP-1
|Increase eNOS/NO; Reduce LDL, VCAM-1, ICAM-1,
E-selectin, MMP-2, and NF-κB
||Curcumin||Reduce LDL, VCAM-1, ICAM-1, MMP-2, MMP-9,
TNF-α, and NF-κB
||Reduce LDL, VCAM-1, ICAM-1, and MMP-9||[7,24]|
||Paeonol||Reduce VCAM-1, ICAM-1, and TNF-α||[42,43]|
|Total glucosides of peony||Reduce LDL and TNF-α|||
||Increase eNOS/NO; reduce LDL, VCAM-1,
ICAM-1, and NF-κB
||2,3,5,4'-tetrahydroxystilbene-2-O-beta-D-glucoside (TSG)||Increase eNOS/NO; reduce LDL,
VCAM-1, and ICAM-1
||Berberine||Reduce LDL, ox-LDL, VCAM-1, ICAM-1, MMP-9,
MCP-1, NF-κB, and TNF-α
|Red yeast rice||
||Increase eNOS/NO; reduce LDL, VCAM-1, ICAM-1,
MMP-9, MMP-2, and NF-κB
Tanshinone IIA, another compound derived from
Hung et al.  report that a low dose (0.015 mg/mL) of
8. Acupuncture and atherosclerosis-related diseases
In addition to herbal medicine, acupuncture has been used for a long time in the treatment of cardiovascular disease in Asia. Acupuncture is applied in the treatment of hypertension and hyperlipidemia, which are risk factors leading to atherosclerosis. Kim et al.  demonstrated that electroacupuncture on the
9. Mind–body exercise of
tai chi and yogi
10. Meditation, mind, and atherosclerosis
Certain mental disorders and stress are conducive to atherosclerosis. Kroenke et al.  revealed that a negative mood is predictive of a greater progression of calcified atherosclerosis, compared to a positive mood. Everson-Rose et al.  found that high levels of stress, hostility, and depressive symptoms are associated with a significantly increased risk of incident stroke or transient ischemic attacks in middle-aged and older adults. Stillman et al.  and Wang et al.  also noted that anxiety can potentially predict a worse outcome through worsening of vascular function in patients with coronary atherosclerotic disease.
Meditation is an alternative medicine practice for mental and physical health. It has salutary effects on patients with anxiety [61, 62], depression [61, 63], and stress [64, 65]. Some articles report that meditation can calm the emotions and produce beneficial effects on the cardiovascular system, particularly with regard to vascular aspects [66-68]. Walton et al.  advocate meditation to reduce traditional and novel risk factors for cardiovascular diseases; for example, meditation (1) decreases blood pressure; (2) reduces the use of tobacco and alcohol; (3) lowers the cholesterol level and lipid oxidation; and (4) decreases psychosocial stress.
The mechanism and neurobiological effects of mindfulness meditation involve (1) deactivation of the default mode network, which generates spontaneous thoughts, contributes to the maintenance of the autobiographical self, and is associated with anxiety and depression; (2) the anterior cingulate cortex, which underpins attention functions; (3) the anterior insula, which is associated with the perception of visceral sensation, the detection of the heartbeat and respiratory rate, and the affective response to pain; (4) the posterior cingulate cortex, which helps one to understand the context from which a stimulus emerges; (5) the temporoparietal junction, which assumes a central role in empathy and compassion; and (6) the amygdala, which is implicated in fear responses .
11. Further research
There are few studies on formulas or single herbal drugs interaction in the treatment of atherosclerosis. In accordance with evidence-based medicine, well-designed and conducted clinical studies such as randomized control clinical trials will be necessary in the future.
Atherosclerosis-related diseases are the primary causes of death. In addition to standard treatment, complementary therapy needs to be face up. Traditional Chinese medicine is a popular complementary and alternative medicine (CAM) in East Asia and throughout the world. There is increasing scientific evidence demonstrating that TCM has potential for treating atherosclerosis and its associated conditions. Acupuncture,
Rafieian-Kopaei M, Setorki M, Doudi M, Baradaran A, Nasri H. Atherosclerosis: process, indicators, risk factors and new hopes. Int J Prevent Med. 2014;5:927-946.
Tedgui A, Mallat Z. Cytokines in atherosclerosis: pathogenic and regulatory pathways. Physiol Rev. 2006;86:515-581.
Chen Z, Xu H. Anti-Inflammatory and Immunomodulatory Mechanism of Tanshinone IIA for Atherosclerosis.Evidence-based complementary and alternative medicine: eCAM. 2014;2014:267976. doi: 10.1155/2014/267976.
Liu Y, Zhang HG, Jia Y, Li XH. Panax notoginseng saponins attenuate atherogenesis accelerated by zymosan in rabbits. Biol Pharma Bull. 2010;33:1324-1330.
Zhang Q, Wang GJ, A JY, Wu D, Shu LL, Ma B, Du Y. Application of GC/MS-based metabonomic profiling in studying the lipid-regulating effects of Ginkgo biloba extract on diet-induced hyperlipidemia in rats. Acta Pharmacol Sin. 2009;30:1674-1687. doi: 10.1038/aps.2009.173.
Shishodia S. Molecular mechanisms of curcumin action: gene expression. Biofactors. 2013;39:37-55. doi: 10.1002/biof.1041.
Zhang J, Liang R, Wang L, Yan R, Hou R, Gao S, Yang B. Effects of an aqueous extract of Crataegus pinnatifida Bge. var. major N.E.Br. fruit on experimental atherosclerosis in rats. Jf Ethnopharmacol. 2013;148:563-569. doi: 10.1016/j.jep.2013.04.053.
Li J, Chen CX, Shen YH. Effects of total glucosides from paeony (Paeonia lactiflora Pall) roots on experimental atherosclerosis in rats. Jf Ethnopharmacol. 2011;135:469-475. doi: 10.1016/j.jep.2011.03.045.
Hwang SM, Kim JS, Lee YJ, Yoon JJ, Lee SM, Kang DG, Lee HS. Anti-diabetic atherosclerosis effect of Prunella vulgaris in db/db mice with type 2 diabetes. Am J Chin Med. 2012;40:937-951. doi: 10.1142/S0192415X12500693.
Gao X, Hu YJ, Fu LC. Blood lipid-regulation of stilbene glycoside from polygonum multiflorum. Zhongguo Zhong Yao Za Zhi. 2007;32:323-326.
Kong W, Wei J, Abidi P, Lin M, Inaba S, Li C, Wang Y, Wang Z, Si S, Pan H, Wang S, Wu J, Wang Y, Li Z, Liu J, Jiang JD. Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins. Natur Med. 2004;10:1344-1351.
Hsieh YS, Kuo WH, Lin TW, Chang HR, Lin TH, Chen PN, Chu SC. Protective effects of berberine against low-density lipoprotein (LDL) oxidation and oxidized LDL-induced cytotoxicity on endothelial cells. J Agri Food Chem. 2007;55:10437-10445.
Yang CW, Mousa SA. The effect of red yeast rice (Monascus purpureus) in dyslipidemia and other disorders. Compl Ther Med. 2012;20:466-474. doi: 10.1016/j.ctim.2012.07.004.
Ou HC, Lee WJ, Lee IT, Chiu TH, Tsai KL, Lin CY, Sheu WH. Ginkgo biloba extract attenuates oxLDL-induced oxidative functional damages in endothelial cells. J Appl Physiol. 2009;106:1674-1685. doi: 10.1152/japplphysiol.91415.2008.
Zhang W, Xu XL, Wang YQ, Wang CH, Zhu WZ. Effects of 2,3,4',5-tetra hydroxystilbene 2-O-beta-D-glucoside on vascular endothelial dysfunction in atherogenic-diet rats. Plant Med. 2009;75:1209-1214. doi: 10.1055/s-0029-1185540
Zhu XY, Li P, Yang YB, Liu ML. Xuezhikang, extract of red yeast rice, improved abnormal hemorheology, suppressed caveolin-1 and increased eNOS expression in atherosclerotic rats. PLoS One. 2013;8:e62731. doi: 10.1371/journal.pone.0062731.
Zeng Y, Song JX, Shen XC. Herbal remedies supply a novel prospect for the treatment of atherosclerosis: a review of current mechanism studies. Phytother Res. 2012;26:159-167. doi: 10.1002/ptr.3587.
Chen FL, Yang ZH, Liu Y, Li LX, Liang WC, Wang XC, Zhou WB, Yang YH, Hu RM. Berberine inhibits the expression of TNFalpha, MCP-1, and IL-6 in AcLDL-stimulated macrophages through PPARgamma pathway. Endocrine. 2008;33:331-7. doi: 10.1007/s12020-008-9089-3.
Singh V, Rana M, Jain M, Singh N, Naqvi A, Malasoni R, Dwivedi AK, Dikshit M, Barthwal MK. Curcuma oil attenuates accelerated atherosclerosis and macrophage foam-cell formation by modulating genes involved in plaque stability, lipid homeostasis and inflammation. Brit J Nutri. 2014;13:1-14.
Martin-Ventura JL, Blanco-Colio LM, Tunon J, Munoz-Garcia B, Madrigal-Matute J, Moreno JA, Vega de Ceniga M, Egido J. Biomarkers in cardiovascular medicine. Revista española de cardiología. 2009;62:677-688.
Liu G, Wang B, Zhang J, Jiang H, Liu F. Total panax notoginsenosides prevent atherosclerosis in apolipoprotein E-knockout mice: Role of downregulation of CD40 and MMP-9 expression. J Ethnopharmacol. 2009;126:350-4. doi: 10.1016/j.jep.2009.08.014.
Tsai KL, Chang YL, Huang PH, Cheng YH, Liu DH, Chen HY, Kao CL. Ginkgo biloba extract inhibits oxidized low-density lipoprotein (oxLDL)-induced matrix metalloproteinase activation by the modulation of the lectin-like oxLDL receptor 1-regulated signaling pathway in human umbilical vein endothelial cells. J Vasc Surg. 2014;S0741-5214:01124. doi: 10.1016/j.jvs.2014.05.098.
Yu YM, Lin HC. Curcumin prevents human aortic smooth muscle cells migration by inhibiting of MMP-9 expression. Nutri, Metabol Cardio Dis. 2010;20:125-32. doi: 10.1016/j.numecd.2009.03.001.
Shin IS, Lee MY, Lim HS, Ha H, Seo CS, Kim JC, Shin HK. An extract of Crataegus pinnatifida fruit attenuates airway inflammation by modulation of matrix metalloproteinase-9 in ovalbumin induced asthma. PLoS One. 2012;7:e45734. doi: 10.1371/journal.pone.0045734.
Huang Z, Meng S, Wang L, Wang Y, Chen T, Wang C. Suppression of oxLDL-induced MMP-9 and EMMPRIN expression by berberine via inhibition of NF-kappaB activation in human THP-1 macrophages. The anatomical record: Adv Integ Anat Evol Biol. 2012;295:78-86. doi: 10.1002/ar.21489.
Lin CP, Huang PH, Tsai HS, Wu TC, Leu HB, Liu PL, Chen YH. Monascus purpureus-fermented rice inhibits tumor necrosis factor-alpha-induced upregulation of matrix metalloproteinase 2 and 9 in human aortic smooth muscle cells. J pharm pharmacol. 2011;63:1587-94. doi: 10.1111/j.2042-7158.2011.01364.x.
Zhou L, Zuo Z, Chow MS. Danshen: an overview of its chemistry, pharmacology, pharmacokinetics, and clinical use. J Clin Pharmacol. 2005;45:1345-1359.
Xing YL, Zhou Z, Agula, Zhong ZY, Ma YJ, Zhao YL, Xiao XH, Wang SQ. Protocatechuic aldehyde inhibits lipopolysaccharide-induced human umbilical vein endothelial cell apoptosis via regulation of caspase-3. Phytother Res. 2012;26:1334-1341. doi: 10.1002/ptr.3720.
Moon CY, Ku CR, Cho YH, Lee EJ. Protocatechuic aldehyde inhibits migration and proliferation of vascular smooth muscle cells and intravascular thrombosis. Biochem Biophys Res Comm. 2012;423:116-121. doi: 10.1016/j.bbrc.2012.05.092.
Ang KP, Tan HK, Selvaraja M, Kadir AA, Somchit MN, Akim AM, Zakaria ZA, Ahmad Z. Cryptotanshinone attenuates in vitro oxLDL-induced pre-lesional atherosclerotic events. Plant Med. 2011;77:1782-7. doi: 10.1055/s-0030-1271119.
Yang TL, Lin FY, Chen YH, Chiu JJ, Shiao MS, Tsai CS, Lin SJ, Chen YL. Salvianolic acid B inhibits low-density lipoprotein oxidation and neointimal hyperplasia in endothelium-denuded hypercholesterolaemic rabbits. J Sci Food Agri. 2011;91:134-141. doi: 10.1002/jsfa.4163.
Chen YH, Lin SJ, Ku HH, Shiao MS, Lin FY, Chen JW, Chen YL. Salvianolic acid B attenuates VCAM-1 and ICAM-1 expression in TNF-alpha-treated human aortic endothelial cells. J Cell Biochem. 2001;82:512-521.
Lin SJ, Lee IT, Chen YH, Lin FY, Sheu LM, Ku HH, Shiao MS, Chen JW, Chen YL. Salvianolic acid B attenuates MMP-2 and MMP-9 expression in vivo in apolipoprotein-E-deficient mouse aorta and in vitro in LPS-treated human aortic smooth muscle cells. J Cell Biochem. 2007;100:372-384.
Jia LQ, Yang GL, Ren L, Chen WN, Feng JY, Cao Y, Zhang L, Li XT, Lei P. Tanshinone IIA reduces apoptosis induced by hydrogen peroxide in the human endothelium-derived EA.hy926 cells. J Ethnopharmacol. 2012;143:100-108. doi: 10.1016/j.jep.2012.06.007.
Xu S, Liu Z, Huang Y, Le K, Tang F, Huang H, Ogura S, Little PJ, Shen X, Liu P. Tanshinone II-A inhibits oxidized LDL-induced LOX-1 expression in macrophages by reducing intracellular superoxide radical generation and NF-kappaB activation. Translational research: J Lab Clin Med. 2012;160:114-124. doi: 10.1016/j.trsl.2012.01.008.
Gao S, Liu Z, Li H, Little PJ, Liu P, Xu S. Cardiovascular actions and therapeutic potential of tanshinone IIA. Atherosclerosis. 2012;220:3-10. doi: 10.1016/j.atherosclerosis.2011.06.041.
Hung YC, Wang PW, Pan TL. Functional proteomics reveal the effect of Salvia miltiorrhiza aqueous extract against vascular atherosclerotic lesions. Biochim Biophys Acta. 2010;1804:1310-1321. doi: 10.1016/j.bbapap.2010.02.001.
Wan JB, Lee SM, Wang JD, Wang N, He CW, Wang YT, Kang JX. Panax notoginseng reduces atherosclerotic lesions in ApoE-deficient mice and inhibits TNF-alpha-induced endothelial adhesion molecule expression and monocyte adhesion. J Agri Food Chem. 2009;57:6692-7. doi: 10.1021/jf900529w.
Chen YH, Lin SJ, Chen YL, Liu PL, Chen JW. Anti-inflammatory effects of different drugs/agents with antioxidant property on endothelial expression of adhesion molecules. Cardio Hematol Dis Drug Targ. 2006;6:279-304.
Zhang S, Chen B, Wu W, Bao L, Qi R. Ginkgolide B reduces inflammatory protein expression in oxidized low-density lipoprotein-stimulated human vascular endothelial cells. J Cardio Pharmacol. 2011;57:721-7. doi: 10.1097/FJC.0b013e31821a50a8.
Zhao JF, Ching LC, Huang YC, Chen CY, Chiang AN, Kou YR, Shyue SK, Lee TS. Molecular mechanism of curcumin on the suppression of cholesterol accumulation in macrophage foam cells and atherosclerosis. Mol Nutri Food Res. 2012;56:691-701. doi: 10.1002/mnfr.201100735.
Pan LL, Dai M. Paeonol from Paeonia suffruticosa prevents TNF-alpha-induced monocytic cell adhesion to rat aortic endothelial cells by suppression of VCAM-1 expression. Phytomedicine. 2009;16:1027-32. doi: 10.1016/j.phymed.2009.04.003.
Nizamutdinova IT, Oh HM, Min YN, Park SH, Lee MJ, Kim JS, Yean MH, Kang SS, Kim YS, Chang KC, Kim HJ. Paeonol suppresses intercellular adhesion molecule-1 expression in tumor necrosis factor-alpha-stimulated human umbilical vein endothelial cells by blocking p38, ERK and nuclear factor-kappaB signaling pathways. Int Immunopharmacol. 2007;7:343-350.
Park SH, Koo HJ, Sung YY, Kim HK. The protective effect of Prunella vulgaris ethanol extract against vascular inflammation in TNF-alpha-stimulated human aortic smooth muscle cells. BMB Rep. 2013;46:352-357.
Yao W, Huang C, Sun Q, Jing X, Wang H, Zhang W. Tetrahydroxystilbene Glucoside Protects Against Oxidized LDL-Induced Endothelial Dysfunction via Regulating Vimentin Cytoskeleton and its Colocalization with ICAM-1 and VCAM-1. Cell Physiol Biochem. 2014;34:1442-1454. doi: 10.1159/000366349.
Huang Z, Cai X, Li S, Zhou H, Chu M, Shan P, Huang W. Berberine attenuated monocyte adhesion to endothelial cells induced by oxidized low density lipoprotein via inhibition of adhesion molecule expression. Mol Med Rep. 2013;7:461-465. doi: 10.3892/mmr.2012.1236.
Lin CP, Lin YL, Huang PH, Tsai HS, Chen YH. Inhibition of endothelial adhesion molecule expression by Monascus purpureus-fermented rice metabolites, monacolin K, ankaflavin, and monascin. J Sci Food Agri. 2011;91:1751-1758. doi: 10.1002/jsfa.4371.
Xie X, Wang Y, Zhang S, Zhang G, Xu Y, Bi H, Daugherty A, Wang JA. Chinese red yeast rice attenuates the development of angiotensin II-induced abdominal aortic aneurysm and atherosclerosis. J Nutri Biochem. 2012;23:549-556. doi: 10.1016/j.jnutbio.2011.02.011.
Li YI, Elmer G, Leboeuf RC. Tanshinone IIA reduces macrophage death induced by hydrogen peroxide by upregulating glutathione peroxidase. Life Sci. 2008;83:557-562. doi: 10.1016/j.lfs.2008.08.003.
Kim DD, Pica AM, Duran RG, Duran WN. Acupuncture reduces experimental renovascular hypertension through mechanisms involving nitric oxide synthases. Microcirculation. 2006;13:577-585.
Tian JY, Wang Q, Chen YF, Xiao Y, Yue W, Zhang HX. Effect of electroacupuncture stimulation of “Fenglong” (ST 40) on expression of inflammatory cytokines of celiac macrophages in hyperlipidemia rats. Zhen Ci Yan Jiu. 2014;39:282-287.
Xiao Y, Le W, Huang H, Zhou L, Tian JY, Chen YF. Effect of electroacupuncture of “Fenglong” (ST 40) on levels of blood lipid and macrophage TNF-alpha and IL-6 in hyperlipidemic rats. Zhen Ci Yan Jiu. 2013;38:459-464.
Li M, Cai RL, Sun X, Hu L, Wang KM, He L, Peng CY. Effects of electroacupuncture intervention on blood lipid levels and expression of CD 40 L and MMP-9 in the coronary artery tissue in coronary heart disease rats. Zhen Ci Yan Jiu. 2013;38:123-128.
World Health Organization Regional Office for the Western Pacific (WPRO). WHO Standard Acupuncture Point Locations in the Western Pacific Region. WPRO: Manila; 2009. p. 64, 66, 107, 154. ISBN 978-92-9061-248-7.
Lan C, Chen SY, Wong MK, Lai JS. Tai chi chuan exercise for patients with cardiovascular disease. Evidence-based complementary and alternative medicine: eCAM. 2013;2013:983208. doi: 10.1155/2013/983208.
Pal A, Srivastava N, Tiwari S, Verma NS, Narain VS, Agrawal GG, Natu SM, Kumar K. Effect of yogic practices on lipid profile and body fat composition in patients of coronary artery disease. Comp Ther Med. 2011;19:122-127. doi: 10.1016/j.ctim.2011.05.001.
Kroenke CH, Seeman T, Matthews K, Adler N, Epel E. Mood patterns based on momentary assessment of positive and negative moods over a day and coronary artery calcification in the CARDIA study. Psychosom Med. 2012;74:526-534. doi: 10.1097/PSY.0b013e3182583e68.
Everson-Rose SA, Roetker NS, Lutsey PL, Kershaw KN, Longstreth WT Jr, Sacco RL, Diez Roux AV, Alonso A. Chronic stress, depressive symptoms, anger, hostility, and risk of stroke and transient ischemic attack in the multi-ethnic study of atherosclerosis. Stroke. 2014;45:2318-2323. doi: 10.1161/STROKEAHA.114.004815.
Stillman AN, Moser DJ, Fiedorowicz J, Robinson HM, Haynes WG. Association of anxiety with resistance vessel dysfunction in human atherosclerosis. Psychosom Med. 2013;75:537-544. doi: 10.1097/PSY.0b013e31829a0ae3.
Wang G, Cui J, Wang Y, Deng B, Liang X, Bai J, Guo S, Yang Z, Huang L, Li C. Anxiety and adverse coronary artery disease outcomes in Chinese patients. Psychosom Med. 2013;75:530-536. doi: 10.1097/PSY. 0b013e3182984317.
Goyal M, Singh S, Sibinga EM, Gould NF, Rowland-Seymour A, Sharma R, Berger Z, Sleicher D, Maron DD, Shihab HM, Ranasinghe PD, Linn S, Saha S, Bass EB, Haythornthwaite JA. Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. JAMA Internal Med. 2014;174:357-368. doi: 10.1001/jamainternmed.2013.13018.
Orme-Johnson DW, Barnes VA. Effects of the transcendental meditation technique on trait anxiety: a meta-analysis of randomized controlled trials. J Alt Comp Med. 2014;20:330-341. doi: 10.1089/acm.2013.0204.
Jain FA, Walsh RN, Eisendrath SJ, Christensen S, Rael Cahn B. Critical analysis of the efficacy of meditation therapies for acute and subacute phase treatment of depressive disorders: a systematic review. Psychosomatics. 2014; pii: S0033-3182(14)00167-4. doi: 10.1016/j.psym.2014.10.007
Ruotsalainen JH, Verbeek JH, Mariné A, Serra C. Preventing occupational stress in healthcare workers. The Cochrane database of systematic reviews. 2014;12:CD002892. doi: 10.1002/14651858.CD002892.pub4
Hartley L, Mavrodaris A, Flowers N, Ernst E, Rees K. Transcendental meditation for the primary prevention of cardiovascular disease. The Cochrane database of systematic reviews. 2014;12:CD010359. doi: 10.1002/14651858.CD010359.pub2.
Koike MK, Cardoso R. Meditation can produce beneficial effects to prevent cardiovascular disease. Horm Mol Biol Clin Invest. 2014;18:137-143. doi: 10.1515/hmbci-2013-0056.
Barnes VA, Orme-Johnson DW. Prevention and treatment of cardiovascular disease in adolescents and adults through the transcendental meditation(®) Program: a research review update. Curr Hyperten Rev. 2012;8:227-242.
Walton KG, Schneider RH, Nidich S. Review of controlled research on the transcendental meditation program and cardiovascular disease. Risk factors, morbidity, and mortality. Cardiol Rev. 2004;12:262-266.
Ngô TL. Review of the effects of mindfulness meditation on mental and physical health and its mechanisms of action. Santé mentale au Québec. 2013;38:19-34.